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proteins into their polypeptide subunits. Point 3, it is interesting to learn that some researchers have found that children by combing their hair in bed can develop proteinuria. We have no experience with such forms of exercise but have demonstrated that long-term Type 1 diabetic patients with normal urinary albumin excretion rate during exercise with a workload of 600 kpm/min increased urinary albumin excretion rate only from 6 _+ 0.6 to 9 _+ 1.0 gg/min, not different from non-diabetic subjects [5]. The fractional albumin clearance was also similar during exercise in these two groups. Point 4, the role of the intraglomerular driving forces (including hydrostatic pressure) for the filtration of water and albumin are well known but, as we pointed out to Dr. Simpson in our reply to his first letter [2, 3], there is no evidence from our own or other studies in diabetic subjects indicating that persistently increased microalbuminuria in Type 1 diabetic patients is caused by an increase of driving forces including blood viscosity [6]. Point 5, please see our reply to Dr. Simpson's first letter [3]. As pointed out genetic deficiency in the biosynthesis of extracellular matrix will under normoglycaemic conditions not normally lead to diabetic complications, only during hyperglycaemia. It is, therefore, by no means to be excluded that diabetic complications can reverse during long-term normoglycaemia. We agree with Dr. Simpson that our ideas may be wrong but the extensive paper of Dr. Simpson [7] does not include arguments against our hypothesis.

increases the difficulty of respiration, and may itself be immediately the cause of death.
The presence of extravasated blood alone in the cavity of the chest, is not so dangerous a circumstance as those who have Rot witnessed such accidents are inclined to imagine. When the collection is not considerable, the blood is readily absorbed; Jt is first isolated by adhesions of the adjacent parts around it, and a cyst is formed, the vessels of which take up the contained hlood; or else suppuration of the corresponding part of the integuments of the chest takes place, by which it is evacuated, when the wound is not conveniently placed, or has been healed; or when vent is not given to it by the common operation for empyema. The parietes of the cyst then collapse, and at length approach each other so as to obliterate their cavity.
When the collection is considerable, the natural efforts are ordinarily insufficient to effect its removal, especially if the accumulation has been suddenly produced: the great mechanical pressure of the blood on the vessels of the surrounding pleura prevents their exciting their absorbent faculties; and this mem brane often becomes inflamed, and adds to the accumulation by pouring out serous or purulent matter. If a passage for the retained fluid is not opened by art, it at length produces the death of the patient, more certainly when both sides of the thoracic cavity are engaged, by destroying the functions of the lungs, as well as by causing extensive disease of the pleura and other adjacent organs. In this case, then, the operation of paracentesis of the thorax becomes requisite for the preservation of the patient's life. The many instances in which it has been practised with a favourable result, show that it is not in itself .a very dangerous operation. The most important circumstances respecting it are to indicate with accuracy, 1?, the cases to which it is appropriate; 2?, the signs of accumulation of fluid * In tlie third volume, p. 441', of his Camjiugncs Chirurgicalcs, 240 Foreign Medical Science and Literature. in the thoracic cavity, which the natural efforts are incapable of removing; 3?, the period at which it should be resorted to.
The species of cases to which it is applicable have been al* ready designated, and the inefEcacy of the natural efforts to remove the fluid may be generally determined, if nine days have elapsed without this having been either wholly or in great; part effected. The signs of an accumulation of fluid in the cavity of the chest, are, a sense of oppression and straitness of respiration ; immobility of the lower ribs of the corresponding side, and pain on pressure of the finger in their intervals, through which the finger may distinguish the undulation oi1 impulse of the fluid; difficulty of lying on the opposite side; sound made by the fluctuation of the fluid, often perceptible by the patient himself, and sometimes by the by-standers, especially when the collection is abundant .and chronic ; the absence of the natural hollow sound on percussion of the chest; and, lastly, it is particularly characterized by an ecchymosis or cedematous tumefaction, situate behind the hypochondre on the side affected. This sign has been invariably present in all the cases seen by the author, and is the only one which is invariably pathognomonic.
Supposing that the necessity of the operation is recognized, it is necessary to determine when it should be performed. It would be imprudent to practise it too early, because this would favour the occurrence of a new internal hemorrhage; and, if the natural efforts were disposed for the absorption of the fluid, this salutary process would be averted. It is proper to wait until the wounded vessels have become healed, consolidated, and the accidents dependant on the pressure and irritation of the accumulated fluid are developed. These ordinarily manifest themselves, so that they may be distinguished from the' primary consequences, between the fifth and ninth days. The operation for empyema, for the consequences of wounds penetrating the cavity of the chest, cannot be practised as an efficacious remedy before the seventh day ; and is but rarely successful if it is deferred beyond the eleventh, or at the utmost the fifteenth, day. Before the first period we cannot be certain of its necessity ; and, if the second be passed over without the evacuation of the fluid, the patient is exposed to imminent danger of perishing from suffocation.
The following abstract of a case detailed by the author, will present many interesting facts to the surgical practitioner, in exemplification of some of the foregoing remarks, as well as show the curious resources of the natural powers for remedying of injuries of the kind under consideration. An athletic grenadier, twenty-two years of age, received, in Baron Larrey on Wounds of ih'c Thordi? 2il horning, a thrust from a straight sword, by which he was ran completely through the chest, at the upper part of the left side. His adversary had a great deal of difficulty in withdrawing his sword from his body; Notwithstanding the abundant hemorrhage which followed the extraction of the weapon, the soldier did not fall, and he reached, on foot and without the assistance ?f any person, the nearest house, which was, however, at a considerable distance from the place of combat. There his wounds "Were bound up with napkins, and he was immediately afterwards carried to the military hospital Gros-Caillou, where he Was received and attended to by Baron Larrey. The great quantity of blood which the patient had lost, had produced such a state of debility, that his face and lips were completely pallid, his voice extinct, his eye-lids half closed, and his eyes dull and motionless, his extremities perfectly cold, and his pulse hardly sensible. On examining the wounds, that by which the sword entered Was found to occupy the anterior part of the space between the first and second ribs ; it was quite close to the sternum, which Was itself a littlfe cut: it was about ten lines in length. The Second, made by the point of the sword in passing out of the chest, was situate between the superior and posterior angle of the scapula and the third dorsal vertebra, and corresponded With the space between the second and third ribs : this was only six or seven lines in length. The edges of the wounds and the surrounding parts were considerably tumefied by emphysema. On the edges of the wounds being separated and made to correspond with the openings in the intercostal muscles and pleura, ^Qrid and frothy blood escaped from them in powerful jets. These emissions were followed by symptoms of suffocation, a?d the patient seemed to be menaced with instant death. The wounds were extended externally, so that no cul-de-sac 0r pouch might exist under the integuments; and, to bring on a parallel the openings in the integuments and those of the immediate parietes of the chest, they were respectively brought together by adhesive plaster, which, with compresses and bandies, constituted the dressing employed. The application of some cupping-glasses with the scarificator, in their immediate vicinity, removed the surrounding emphysema. The whole of toe patient's body was rubbed with hot camphorated oil of chamomile, and the extremities and abdomen afterwards covered with hot flannel. The state of the patient soon improved ; his Aspiration became less laborious and deeper ; his pulse and the Warmth of the body became gradually developed ; he recovered the use of his senses ; and in a few hours ever}-thing indicated that the internal hemorrhage had ceased. Some chicken-broth Wo, 25g. 21 242 Foreign Medical Science and Literature. with nitre was ordered to constitute his drink and the whole'of his nourishment.
On the evening of the same day some fever, with all the signs of re-action, appeared. Dr. Grimelle, a military surgeon, to whom the watching of the patient was particularly confided by Baron Larrey, then bled him, and applied cupping-glasses over the whole of the left side of the chest, some with, and others without, the scarificator. The dressing was not disturbed. The patient remained tolerably calm during the night.
On the ensuing morning, the pulse was rapid and thrilling ; the heat of the surface was excessive, the cheeks red; there were deep ana acute pains in the region of the wounds, and expectoration of a rather large quantity of dark blood. Phlebotomy was repeated ; and iced, acidulated, mucilaginous drinks, to be taken alternately with the chicken-broth, laxative glysters, and nitrated anodyne emulsions during the night, were prescribed. On the third day and during the night, the edges of the posterior wound were suddenly separated, by an effusion of blackish blood, which recurred on the removal of the dressing. This effusion, far from alleviating the patient, augmented the alarming symptoms ; and it was feared that he M ould die whilst the dressing was being renewed. The anterior wound was dressed at the same time, which had also been forced open ; the camphorated embrocations repeated, and the patient placed in a fresh bed.
From this time the patient continued to get better, and he became perfectly tranquil. He remained in this state until the seventh day from that of the accident. A little blackish blood First, the beatings of the heart perceptible externally, which had disappeared in consequence of the displacement which the organ had suffered from left to right from the presence of the &ccumu3ated fluid, at first re-appeared a little on the left of the sternum, then gradually extended from it until they were sensible in the natural situation, and successively still more deeply 2 12 24-4 Foreign Medical Science and Literature ?nd backwardly, so as not to be'evident to the touch at the time the recovery of the patient might be confidently expected.
Secondly, the pulsations of the radial arteries in the two arms presented a sensible difference. Those of the left were wellmarked, regular, and uniform; those of the right, precipitate, and interposed with a half-pulsation, with a character of undulation and retrograde locomotion. Thirdly, the veins of the left arm were not apparent; whilst those of the right remained tumid during the twenty-five or thirty days which immediately followed the operation.
These phenomena continued for a month or six weeks; but at length the pulse in the two arms became in harmony with each other and regular, though the left remained the weakest.
By the fortieth day, the patient felt himself pretty well, and be continued still to improve in health. The pus which escaped from the wound made in the operation had a good appearance, and was reduced to a small quantity. Its evacuation was often accompanied with the issue of membraniform or flocculent slips, ?which the author attributed to exfoliation of the internal surface of the costal pleura. The wounds made by the sword had entirely cicatrized by the thirty-fifth day.
It could be remarked daily, in a very sensible manner, that the parietes of the left side of the chest gradually fell in and approached each other, so as to reduce the volume of the interior cavity : the left nipple had descended an inch lower than the right; the shoulder of the same side was depressed in the same proposition, and the intercostal spaces were considerably reduced in .extent. The right cavity of the chest had enlarged, the author says, in a relative manner.
On the hundredth day after the operation, the patient ate some light food, and walked about the wards of the hospital for several hours in the day, without any support. The wound made in the operation remained fistulous, but it gave vent to but very little pus, which was inodorous and of a good appearance.
The patient arrived at the conclusion of the fourth month from the receipt of the wound, and every thing concurred to assure his recovery. But this soldier, naturally of a headstrong, self-willed, and extremely irascible disposition, now became weary of the regiment to which he was submitted, and, determining to resist his inclinations no longer, gave himself up to every excess which he could commit. One amongst these was the use of spirituous liquors, which he clandestinely procured. The consequences were, an attack of violent inflammation of the heart and its envelopments, which terminated in death in forty-eight hours; the patient going off in a paroxysm of rage, uttering every sort of imprecation, on the 11th Baron Larrey on TVounds of the Thorax. 245 January, 1819, on the hundred and twenty-fifth day after the accident.
The body was opened twenty-four hours afterwards, in the presence of Dr. Ribes, and the other medical officers of the hospital.
The capacity of the left side of the chest was found to be reduced to two-thirds of its natural space: the mediastinum had extended its adhesions to the left as far as the line of union of the cartilaginous with the osseous portions of the ribs. The heart and pericardium occupied the greater part of this cavity, and were situate more backwardly and to the left side, than in the natural state. The portion of the lung which had escaped the effects of the compression of the effused fluid was hepatized, and covered with a villous false membrane which adhered to the pericardium, whilst the latter was throughout so intimately united with the surface of the heart, that it was only "with difficulty a small portion of that membrane could be separated from it. The diaphragm was considerably vaulted on this side. The ribs were thicker than those of the opposite side, as well as more approached together. The reduction of this thoracic cavity was such, that there remained only a small space of a conical form, at the bottom of which was a little purulent matter of a whitish colour. The parietes of this cavity Were lined with layers of membraniform filaments.
The wound made in the operation was fistulous, and situate precisely at the lowest point of the cavity. The wounds made by the sword were perfectly cicatrized.
On examining attentively the course which the weapon had taken in traversing the chest, it was found that the internal mamillary artery had been completely divided ; the superior lobe of the left lung completely traversed, but, whether above or below the arch of the aorta, is not stated ; and the intercostal artery divided in the situation of the posterior wound.
The manner in which the natural efforts had effected, to a M. Virey on the Natural History of Medicines, tfc. 347 classes odours, according to their resemblance with those of several well-known powerfully-odorific substances. He then considers odours in respect to the use made of them for luxurious purposes; and the effects of combination, putrefaction, heat, air, light, and various chemical re-actions on them; and, finally, of their chemical nature.
Powerfully-odorous bodies are generally also strongly sapid ; and animals in search of their food examine them previously to resorting to taste. Substances of a disagreeable odour to any particular animal are but rarely fit for the nutrition of that animal. Some substances of a disagreeable smell are, however, 1 ? .
pleasant to the taste of an individual, and these are generally proper food for it. M. Virey distinguishes the odours of aliments into the following species: 1, the musty; 2, the oleraceous; 3, the leguminous; 4, the umbelliferous; 5, the antiscorbutic; 6, that of fruits; 7, the dulcid ; 8, the oleaginous ; 9, that of raw and cooked flesh ; 10, that of fish; 11, that of garlic; 12, the aromatic. We pass over the exemplifications ?f these, as not being of much importance or utility, any more *han the classification itself, which is open to many objections.
Several medicines, the author remarks, seem to act on the body only by means of their odour; and many of them, as some of the purgatives, lose their medicinal qualities with their nauseous smell. Thus, when rhubarb is deprived of its smell by being torrefied, it loses its purgative quality, and becomes only astringent. Some very disagreeable odours seem to produce deleterious effects on the animal body only by their impression on the organ of smell. Some odours have singular effects on the nervous system, and others excite especially certain organs; but "We hardly know what degree of credit to attach to the stories related in exemplification of this proposition.
Linnseus formed seven classes of odours of medicines; namely, the aromatic, fragrant, anibrosiac, alliaceous, hircine, fetid, and nauseous. M. Virey proposes a different arrangement, which is very objectionable; especially because the supposed effects of certain plants on the human body are made the basis of several of the classes, and the source of their applications. They are, l, the nauseous; 2, the vinous or narcotic; 3, the acrid or corrosive; 4, the hircine; 5, a somewhat similar odour, "which may be termed aphrodisiac; 6, that of emmenagogues ; 7, the nidorous; 8, the carminative; 9, the bituminous; ip, the strong or penetrating ; 11, the camphoric ; 12, the aromatic; 13, the balsamic; 14, the resinous; 15, the gummoresinous; l(j, the muscal or ambrosiac; 17, the citronic; 18, that of the lotus species of plants; 19, the acerb; 20, that of kernels containing prussic acid. ...

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Foreign Medical Science and Literature.
The author has arranged the several medicinal substance* tinder those classes; but our limits oblige us to pass over these particulars to matters of more importance. He has not been so successful in designating the qualities of medicinal substances by their odours as by their colours, though much is certainly determined even by the former means.
The rest of the disquisition on this subject contains many curious and interesting observations ; but these are not so closely allied to the especial object of this Journal as to detain our attention on the present occasion. This is also the case with the greater part of that on the tastes of medicines. Besides, the varieties in the mode of sensation of different individuals prevent any very precise conclusions respecting the wholesome or unwholesome properties of; plants being formed from their agreeable or unpleasant taste. Though it may be stated in a general manner, that those which are nauseous to the taste are more or less noxious to man in the state of health. Besides the objections to the indications of taste above mentioned, it may be observed, that what is poison for one animal is food for another, even among those whose organization is not considerably at variance. Thus, thephellandrium aquuticum, which is poisonous to man and to the horse, is eagerly sought after for food by the bullock.
Ivl. Virey distinguishes the tastes of medicines into excitant, acrid, bitter, aromatic, saline, styptic or astringent, virulent, acid, sweet, insipid, oily, mucilaginous, and narcotic. The qualities of the simple excitants are sufficiently distinguished b}r the sense of the appellation. Those which are acrid admit of some subdivisions which merit consideration. The alliaceous acids, the type of which is garlic and other analogous vegetables, as squills, colchicum, the bulbs of the anthencum and amaryllis, and, in general, of several of the lilies, asphodels, the irides, &e. although this state is, in some of these instances, joined with a nauseous, purgative, and even poisonous, principle. These substances strongly excite the system, and especially the mucous membranes. The antiscorbutic acrids, the type of which is the radish, cresses, cochlearia, mustard, and, in general, all the cruciferous plants. This acridness is fu gacious, and disappears on desiccation of the vegetables. It is decomposed also by heat, and furnishes either sulphur or sulphurated hydrogen. Plants containing it excite, especially, the secretion of urine. The spicy acrids vary but little in their qualities from simple excitants. The caustic acrids are for the most part dangerous when taken inwardly. Many plants which grow in water become then possessed of this quality in a greater degree than when they grow on dry land, and several of them acquire also proporuoiwtc poisonous qualities. Of this kind, M. Virey on the Natural History of Medicines, Xc. 24Q are the polygonum hydropiper, cicuta and several other of the Vmbelliferse, sium, phellandrium, the ranunculacea, the species calea and arum, the nymphcese, the vernal plants of moist soils, as the anemone pulsatilla, the chrysosplenium, &c. Other acrids, naturally caustic, are the aconites, cevadilla, clematis, coculus indicus, the euphorbia, gratiola, the hellebores, the delphinia, staphysagria, the ranunculacea, savine, toxicodendron: several milky plants, as the apocynum, the thymelcea, &c. inflame the skin, and are poisonous when taken into the intestinal canal. Many of them act as drastics, or as emetics.
" The bitters," says M. Virey, " constitute one of the savours the most unpleasant to the taste, and nature leads us to shun them in.
voluntarily. This is indeed with reason, because the greater part of the most intense bitters are poisonous; others purge; others arc joiued with nauseous or fetid savours which excite vomiting. There are some of them, however, which have nothing deleterious, nor even very disagreeable, in them : these arc the aromatic bitters, and the bitter astringents. The latter arc excellent tonics and febrifuges; they strengthen the organic system, excite the appetite and digestion : after a long use they enervate, harden the animal fibre, and produce emaciation. They arc also taken as antiaphrodisiacs; they oppose the development of acidity in the intestinal canal, and destroy worms.
The 3' are successfully employed against arthritic and hypochondriac disorders ; they resist putridity, and solicit the activity of the liver or the secretion of bile." We can distinguish four species of bitterness: 1. The astringent bitter, the type of which is in the cinchona. The vegetables possessed of this property prevent putrefaction, destroy )v.orms and parasitic animals, oppose more or less the course of intermittent fevers, and give tone and vivid colour to the body. particularly allied with nauseating qualities, since, on gently torrefying rhubarb and scammony, or long boiling of asarum, senna, bryony, ricinus, &c. these purgative properties are dissipated with their nauseous taste. The principle of the action of the aromatics appears to reside especially in volatile oils or benzoic acid, or in balsams and resins more or less soluble in our fluids. They affect particularly the nervous system, almost as simple excitants.
The virulent savours are distinguished by the author into those of the mineral, and those of'the organic kingdom. Substances possessing this quality are more or less deleterious to our system.
The most virulent savours of the vegetable kingdom are those of several champignons, of the thymelcea, the plumbago, the greater part of the acrid and bitter apocynea, as the verberae, the strychnos, the milk of the asclepias and cynanchum i that of the lobelia? tupa and urens is caustic ; the bulbs of several ranunculacea, as the sceleratus, flammula, and thora; the aconites, the clematis flammula ; some of the species menispermum, such as the coculus and the rhus toxicodendron ; the acrid milky juices of the euphorbiacese, especially of the hippomane, sapium, adelia venenata, that of the ficus toxicaria and septica, of the ipo toxicaria, &c. are very poisonous, and of an insupportable taste. The simple sweet and almost insipid? (fadeJ as well as mucilaginous savours, are devoid of deleterious qualities. Some mucilages have nauseous or fetid qualities joined with them, as in the narcissus, the asphodels, the irides, and gladiolse, which are poisonous.
The narcotics may be distinguished into, 1, the inebriating ; 2, the nauseous.
The nauseous narcotics are evident poisons, and are rejected by the taste. They were in old times called void poisons, because they appear to render languid vital action; but they are ordinarily accompanied with a more or less irritating and acrid principle, which produces violent convulsions in the midst of the fatal torpor. Such are the plants of the family of solanums in general, the species datura, hyoscyamus, atropa, nicotianaj several fetid champignons, cicuta, phellandrium, ledum palustre, &c. Almost all the solanums, especially the species having black foliage or fruit, develop, in some part of their structure 1 M. Virey on the Natural History of Medicines, Kc. 251 at least, a narcotic and nauseating principle, as the hyoscyamus, belladonna, and stramonium.
After these generalities, the author enters into the particular consideration of medicinal substances.
He first adduces a classification of the qualities he supposes them to possess, than which none can be more objectionable, or show less knowledge ?f the physiology of the human body. He says, l( We may form a graduated scale of the properties of remedies, which will be the inverse of the state of body of the patient. For example, may range thus the principal class of medicines: 1. Narcotics; 2. Delayans, (we give the original, because this is a word of no meaning to English physicians: the truth is, that it has not its equivalent term in the English language, and we shall not furnish matter for ridicule to some English Moliere, by paraphrasing it); 3. Adoucissans ; 4. Nutritives; 5. Fortifiants; Excitants; 7. Purgatives; 8. Acrids." This is too weak a thing for us to attack: besides this, M. Virey, when speaking of particular medicines, describes them as inciswes, discussives, exsiccativcs, depuratives, cephalics ; all which terms, as applied to medicines, are to us as devoid of meaning as the hieroglyphics on the sarcophagus of Alexander.
Mr. Virey distinguishes medicines in the first instance into those of the organic and inorganic kingdoms ; and the former class is subdivided into animal and vegetable. The definition of these, respectively, has certainly defeated the efforts of the best naturalists; Ave need not, therefore, be surprised, that M.
Virey has failed to effect it in a satisfactory manner: yet we expected from him something more nearly correct than what he has produced. He designates animals as being cognizable u by a central cavity for nutrition, by their faculty ot perception by sensual organs, by the power they have of changing their place at will, by parts of generation which they preserve all their life, which have the sense of touch at least, and five senses at the most." Now all naturalists know, that there are animals in which neither nerves nor sensual organs have been seen, which cannot change their place at will, which have no generative organs, and which have no more sense of touch than some plants.
M. Virey first treats of medicines taken from the animal kingdom. Almost the sole thing here, atter giving the natural history of the animals which supply them, is to state those which have been, rather than those which are now, in use. The account is a tolerably good one ; but the flighty disposition of the author often leads him from his proper object. Thus, who would expect to find the following piece of moralitjr in the first page of this part of the work: 46 L'homme, homo sapiens, Lt